Provider Demographics
NPI:1225111271
Name:MED-ECON DRUG INC
Entity Type:Organization
Organization Name:MED-ECON DRUG INC
Other - Org Name:MED-ECON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND DR OF PHCY
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-786-2246
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:WELEETKA
Mailing Address - State:OK
Mailing Address - Zip Code:74880-0758
Mailing Address - Country:US
Mailing Address - Phone:405-786-2246
Mailing Address - Fax:
Practice Address - Street 1:311 W 9TH ST
Practice Address - Street 2:
Practice Address - City:WELEETKA
Practice Address - State:OK
Practice Address - Zip Code:74880-9801
Practice Address - Country:US
Practice Address - Phone:405-786-2246
Practice Address - Fax:405-786-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
OK5150553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3713282OtherOTHER ID NUMBER
OK100236520AMedicaid
3713282OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3713282OtherOTHER ID NUMBER